Healthcare Provider Details

I. General information

NPI: 1124384391
Provider Name (Legal Business Name): ERIN MICHELLE PRELOGER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2012
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9000 W WISCONSIN AVE
MILWAUKEE WI
53226-4874
US

IV. Provider business mailing address

9000 W WISCONSIN AVE
MILWAUKEE WI
53226-4874
US

V. Phone/Fax

Practice location:
  • Phone: 414-337-7050
  • Fax: 414-337-7020
Mailing address:
  • Phone: 414-337-7050
  • Fax: 414-337-7020

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number41368
License Number StateMT
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number67569
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: